Even though paediatric emergency department visits decreased greatly during the COVID-19 pandemic, a newly published study in study in The Lancet Psychiatry based on collaboration between researchers from University College Dublin and the University of Calgary, shows evidence of an increase in emergency department (ED) visits for attempted suicide among children and adolescents in that same period of social isolation.

Senior author Dr Ross Neville, at UCD School of Public Health, Physiotherapy and Sports Science, supervised the study design, which included 42 studies representing over 11 million paediatric ED visits comparing data on visits prior to the pandemic with those during. Dr. Neville analysed the data and summarised the results for the study, which show that, across 18 countries, while there was a 32 per cent reduction in paediatric ED visits for any health indication during the pandemic, there was a 22 per cent increase in children and adolescents going to EDs for suicide attempts.

Dr Neville said: "The data from the study that we included from Ireland actually shows a larger increase, of 39 per cent. Practically speaking, this means that for every 10 emergency department visits during COVID-19, there were approximately 3 more visits associated with attempted suicide compared to pre-pandemic levels."

Dr Sheri Madigan, a clinical psychologist in the Department of Psychology, University of Calgary, Canada, is the lead author on the study, which was co-authored with researchers from The Hospital for Sick Children (SickKids), Toronto, University of Ottawa, and Dr Neville at UCD.

According to Dr Madigan, who is a Canada Research Chair in Determinants of Child Development, the findings are troubling but not surprising. In the summer of 2021, she co-authored a study which found that depression and anxiety symptoms doubled in children and adolescents during the first year of the pandemic, and she cautioned it was a global mental health crisis.

She said: “In our earlier work in the pandemic, we determined that kids were in crisis, and that we needed to bolster services and resources, or it was going to get worse.

“There’s been a debate during the pandemic as to whether the kids are alright or not alright. Now that more data have been published and analysed, we can more precisely answer that question. The kids are, in fact, not alright.”

Regarding the overall reduction in ED visits, Dr Neville suggested that fear of COVID-19 infection and potential stigma for breaking COVID-19 restrictions probably kept people away from EDs for most health conditions during the pandemic. But in that same period, risk factors of mental distress among children and adolescents increased. He added: "There was consensus among our multidisciplinary research team that children have an ability to show resilience in difficult times, but during COVID-19 they potentially were pushed past what is tolerable, beyond their capacity-to-cope threshold."

 

The data collected for the study are drawn from administrative health records and related published studies recorded between 1 January 2020 and 19 December 2021. As ongoing studies on more recent administrative health data have yet to be published, Dr Neville said The Lancet Psychiatry article findings provide the clearest snapshot of the pandemic up to July 2021.

He said: "We will continue to monitor the incoming data to see if this trend of increasing emergency department visits for suicide attempts and suicide ideation among youth continues to climb as the pandemic changes and evolves."

Before the pandemic, approximately one-in-seven children worldwide were experiencing some form of mental illness, but only 25 per cent in serious need of treatment received it. As mental health stressors escalated overwhelmingly during the pandemic, the need for mental health resources increased in kind, and services and supports are still insufficient to meet the overwhelming demand for mental health treatment.

Dr Madigan added that when adolescents experience mental illness, they are at a greater than tenfold increased risk for experiencing mental health disorders later in life. “We’re still facing a mental health crisis and we’re going to be in crisis for a long time to come, because so many kids are now at risk of lifelong mental health difficulties.”

She said: “And we don’t know what’s ahead, so we need to create mitigation strategies now. We need policy decisions that prioritize mental health in the present, and for generations to come.”

 

Dr Ross Neville is at UCD School of Public Health, Physiotherapy and Sports Science. His main collaborator on this study, Professor Sheri Madigan is at the Department of Psychology, Faculty of Arts. Professor Madigan is also member of Alberta Children's Hospital Research Institute, the Owerko Centre at ACHRI, the Hotchkiss Brain Institute and the Mathison Centre of Mental Health Research and Education at the Cumming School of Medicine. She is a Tier II Canada Research Chair in Determinants of Child Development.